AB0269 UTILITY OF DAS28-γGT IN THE ASSESSMENT OF DISEASE ACTIVITY AND CARDIOVASCULAR RISK IN RHEUMATOID ARTHRITIS
Authors: M. Lesturgie Talarek, A. Deloumeau, E. Sorbets, Y. Allanore, J. Avouac
Journal: Annals of the Rheumatic Diseases (2022)

Background ɣGT has been identified as a maker of systemic inflammation and cardiovascular (CV) risk. The composite index DAS28-ɣGT has been developed to allow an evaluation of both joint disease activity and CV risk. Objectives To assess the value of the DAS28-ɣGT in a population of patients with rheumatoid arthritis (RA) requesting cardiologic assessment. Methods Retrospective analysis of RA patients referred to cardio-metabolic day hospitalization in the Rheumatology department of Cochin hospital between February 2021 and January 2022. Criteria for referral were age &gt; 50 years and presence of at least one CV risk factor. DAS28-GGT index was calculated as follows: 0,56 * √TJ-28 + 0,28 * √SJ-28 + 2 * ln (γGT) + 0,14 * GH. This index was analysed according to disease activity measured with the DAS28-CRP, CV risk assessed by the Framingham score and the decision taken by the cardiologist (requirement of complementary explorations and/or therapeutic intervention). Results We included 22 RA patients (17 women), with a mean age of 66±10 years, a disease duration of 21±12 years. Rheumatoid factor was positive in 15 patients, anti-CCP antibodies in 17, and bone erosions in 16. 15 patients received methotrexate, 13 corticosteroids (dose &lt; 10 mg per day), 15 targeted biologic therapies and 3 JAK inhibitors. The mean DAS28-CRP was 2.5±0.9 and the mean DAS28-ɣGT was 7.90±1.90. 2 patients had a DAS28-ɣGT &lt; 5.5, defined in our previous study as high probability of RA remission and low probability of CV risk. These two patients were in remission and their Framingham score was &lt; 10% (low CV risk). No complementary exploration was requested by the cardiologist. 8 patients (6 women, 2 men) had a DAS28-ɣGT index between 5,5 and 7,5, defined in our previous study as high probability of RA remission or low disease activity (LDA) and increased probability of CV risk. As expected, all patients were in remission or in LDA. This population were at higher CV risk: 2 patients had a Framingham score &gt; 20% (high risk), 3 patients a score ranging from 10 to 20% (intermediate risk), and 3 patients a score &lt; 10%. One patient presented carotid atheroma. 4 patients required additional CV explorations and 3 patients necessitated escalation of blood hypertension therapy. Twelve patients (9 women, 3 men) had a DAS28-ɣGT index &gt; 7,5, defined in our previous study as high probability of active RA and/or increased probability of CV risk. 4 patients were in remission, 3 were in LDA and 5 presented moderate disease activity. One patient had a Framingham score &gt; 20%, 4 had a score ranging between 10 and 20% and 6 had a score &lt; 10%. The score was not applicable in an 80-year-old patient. Three other patients had coronary artery disease, including a patient who presented both coronary artery disease and carotid atheroma. 5 patients requested additional CV explorations and 4 required CV therapy escalation (introduction of statin and aspirin in 2 patients and increased blood hypertension therapy in 2 patients). Among these 12 patients, 3 with the highest DAS28-ɣGT values presented CV complications: a 64-year-old woman with a DAS28-ɣGT of 12.8 (DAS28-CRP: 2.89) had carotid atheroma and intermediate lesion of the right artery on coroscanner justifying a coronarography; a 81-year-old woman with a DAS28-ɣGT of 10.67 (DAS29-CRP: 4.62) had atrial fibrillation and aortic stenosis requiring Transcatheter Aortic Valve Implantation; and a 77-year-old woman with a DAS28-ɣGT of 10.35 (DAS28-CRP: 3.89) had ischemic chest pain necessitating rapid explorations in cardiology. Conclusion The DAS28-ɣGT allowed a reliable classification of patients according to the RA activity disease and CV risk. This index may be relevant for CV risk stratification decision making to refer RA patients to a cardiologist. Its validation is in progress in a prospective cohort. References [1]Vergneault H, vandebeuque E, Codullo V, et al, J rheumatol 2020;47(12):1738-1745 Disclosure of Interests None declared